Engaging Payers to Transform Treatment of Substance Use Disorders

Changing how addiction treatment is paid for is critical to improving the quality of these services and increasing patient access to more effective care. Currently, several aspects of the payment system for substance use disorder treatment services perpetuate outdated care models through perverse incentives that hinder adoption of best practices—for example, fee-for-service payments that incentivize high-intensity acute treatment episodes rather than chronic disease management. These payment practices are undergoing scrutiny and many changes have already begun to transform treatment policies. Recognizing a turning point for the engagement of third-party payers and an impetus for progressive payment reform, Shatterproof, a national nonprofit organization, partnered with health insurers to advance the substance use disorder treatment system in the United States and developed eight principles of care. This chapter describes this work and changes to payment models to better support patient needs, community and public health, and the interests of private insurers and health care providers.